Starling v. Gulf Life Insurance Company

• Decision Date: 07 September 1967
• Docket Number: No. 24295.,24295.
• Parties: Louella STARLING, Appellant, v. GULF LIFE INSURANCE COMPANY, Appellee.
• Court: U.S. Court of Appeals — Fifth Circuit

382 F.2d 701 (1967)

Louella STARLING, Appellant, v. GULF LIFE INSURANCE COMPANY, Appellee.

No. 24295.

United States Court of Appeals Fifth Circuit.

September 7, 1967.

Lee R. Williams, Douglas, Ga., Ewing & Williams, Douglas, Ga., of counsel, for appellant.

Larry E. Pedrick, Waycross, Ga., Joseph D. Tindall, Jr., Atlanta, Ga., for appellee.

Before TUTTLE, THORNBERRY and GODBOLD, Circuit Judges.

THORNBERRY, Circuit Judge.

Appellant brought suit against appellee, Gulf Life Insurance Company, in the Superior Court of Coffee County, Georgia on two policies of insurance issued on the life of her husband, William P. Starling, who died on February 16, 1963. The policies had face values of $5,000 and $11,000 respectively. The complaint alleged that Gulf Life wrongfully refused to pay death benefits due on the two policies. In addition, appellant asked for a twenty-five per cent penalty and reasonable attorney's fees under section 56-1206 of the Georgia Code.¹ Gulf Life defended by asserting that the policies had lapsed for nonpayment of premiums and that the insured had made material misrepresentations in certain applications for reinstatement. The suit was timely removed to the court below on the basis of diversity of citizenship.

The district court directed verdicts in favor of Gulf Life on the $11,000 policy and on appellant's request for penalty and attorney's fees but submitted the claim based on the $5,000 policy to the jury. The jury awarded recovery on the $5,000 policy, and Gulf Life did not appeal from the judgment entered on this verdict. Appellant contends here that the trial court erred in granting Gulf Life's two motions for directed verdict and in denying her motion for new trial.² We affirm as to the directed verdict in favor of Gulf Life on the $11,000 policy; but as to the verdict directed against appellant's claim for penalty and attorney's fee on the $5,000 policy, we reverse and remand.

I.

Appellant relied primarily on the testimony of J. W. Moree, one of appellee's former agents. Moree testified that he had been employed by Gulf Life as an agent in Lakeland, Florida, that he had "serviced the account" of the insured while employed in Lakeland, and that he was authorized to collect and did collect premiums on the two policies involved in this case.³ He further testified that in 1962, after collecting premiums on these two policies and furnishing receipts, he failed to remit them to the company before the grace period had expired. As a result, when Gulf Life notified him that the policies had lapsed, he persuaded Mr. Starling to sign two blank applications for reinstatement after telling him what he wanted and after obtaining an affirmative answer to a vague question about the insured's health.⁴

Certain documents were introduced in evidence and identified by Moree as receipts given by him for payments by the insured before the policies could have lapsed in 1962. While appellee questioned whether the receipts really proved this point, they were sufficient when considered with Moree's testimony to sustain a jury finding that the premiums were paid before the policies could have lapsed in 1962.

While appellee was unable to negate the thrust of Moree's testimony, it did present an effective defense to the claim based on the $11,000 policy. This policy had apparently lapsed once before for nonpayment of premiums because the company introduced in evidence an application for its reinstatement, dated September 26, 1961 and showing the insured's home address as being in Pearson, Georgia. There is no evidence in the record connecting Moree with this particular application: He testified that he serviced Mr. Starling's account while both were living in Lakeland, and his testimony about the collection of premiums and applications for reinstatement related to a period of time in 1962. Since there is no evidence to the contrary, we must assume that the $11,000 policy lapsed for nonpayment of premiums in 1961 and that the insured signed the 1961 application for reinstatement with full knowledge of the representations contained therein.

The 1961 application stated that the insured was then in good health and free from all disease or ailments, that since issuance of the policy he had suffered from no illnesses nor been sick from any cause, that he had not consulted, been prescribed for or attended by a physician for any cause, and that he had not been an inmate of any hospital.⁵ The company produced witnesses who testified that between the original issuance of the policy and the date of reinstatement, the insured had been attended by three different physicians, that he had been diagnosed as suffering from gastritis with secondary anemia, that he had been hospitalized as a result of this illness, that on another occasion during the same period he had undergone surgery for removal of a fistula, and that he had been forced to enter the hospital several times for blood transfusions. A doctor who examined Mr. Starling on September 12, 1961 said that he was suffering from anemia blood loss presumably caused by a marginal ulcer and that he had advised the insured of his diagnosis. This same doctor offered the general opinion that the insured was not in good health, that "he was a very sick man." An underwriting official for Gulf Life testified that the applications for reinstatement signed in 1961 and 1962 would have been rejected if these developments had been revealed.

II.

Since this is a diversity case, we apply the substantive law of Georgia. Erie R. R. Co. v. Tompkins, 1938, 304 U.S. 64, 58 S.Ct. 817, 82 L.Ed. 1188, 114 A.L.R. 1487. We first consider the district court's decision to direct a verdict against appellant on the $11,000 policy. Presumably, the verdict was directed on this issue because the only inference which could logically be derived from the evidence was that material misrepresentations were made in the 1961 application and that these misrepresentations substantially increased the risk to the insurer. It is not difficult to find authority to support the action of the district court.

Under Georgia law, material misrepresentations contained in applications for reinstatement of policies are regarded in the same way as those made in original applications. New York Life Ins. Co. v. Odom, 5th Cir. 1937, 93 F.2d 641, cert. denied, 1938, 304 U.S. 566, 58 S.Ct. 948, 82 L.Ed. 1532; Life & Casualty Ins. Co. v. Davis, 1940, 62 Ga.App. 832, 10 S.E.2d 129; New York Life Ins. Co. v. Hollis, 1933, 177 Ga. 805, 171 S.E. 288; Phillips v. New York Life Ins. Co., 1931, 173 Ga. 135, 159 S.E. 696. Thus, insight into the problem before us would be afforded by a Georgia case involving false representations made in an application for life insurance. In Franklin Life Ins. Co. v. State Neon Sign Co., 5th Cir. 1964, 329 F.2d 456, the application in question stated that the insured had not suffered from pain in the chest, palpitation, shortness of breath, heart attack, heart murmur, high blood pressure, varicose veins, or any other disease of the heart or blood vessels. However, it was proved that he had been hospitalized because of coronary thrombosis with myocardial infarction. The district court had refused to direct a verdict for the insurer or to grant its motion for judgment notwithstanding the verdict. On appeal, this Court held that the misrepresentations were material and were not a proper subject for jury inquiry. In reaching this result, Judge Bell summarized the Georgia law on misrepresentations in applications for life insurance:

The law of Georgia is that a false representation contained in an application for insurance which changes the nature, extent, or character of the risk voids the policy. §§ 56-820, 56-908, Code of Georgia, 1933. Code § 56-908 speaks in terms of a material misrepresentation, and Preston v. National Life & Accident Ins. Co., 1943, 196 Ga. 217, 26 S.E.2d 439, 148 A.L.R. 897 construes these statutes to mean a substantial increase in the risk. See our cases of Mutual Benefit Health & Accident Association v. McCranie, 5 Cir., 1949, 178 F.2d 745; and Martin v. Metropolitan Life Insurance Company, 5 Cir., 1951, 192 F.2d 167 in this connection. And where, as here, the applications for insurance are attached to and made a part of the policies, it is not necessary to show any knowledge of the falsity by the insured because there is no issue of fraud or bad faith. It is only necessary to show that the applicant made a material representation that was untrue.

In the instant case, it is not seriously disputed that the insured's policy lapsed for nonpayment of premiums in 1961; and there is no evidence to suggest that the company or its agent was guilty of any irregularity in obtaining the application for reinstatement. Further, the evidence that misrepresentations regarding the insured's health substantially increased the risk to the insurer is uncontradicted. Therefore, the district court correctly directed a verdict in favor of Gulf Life on the $11,000 policy.⁶

III.

The only factor distinguishing appellant's suit on the $5,000 policy from her suit on the $11,000 policy was the testimony of J. W. Moree. Since the representations contained in the 1962 applications for reinstatement had the same untruthful quality as those in the 1961 application, the district court would have been compelled to direct a verdict against appellant on the $5,000 policy but for statements by Moree to the effect that the premiums had been paid before the company claimed a lapse. This testimony created a submissible issue, and the jury responded by awarding recovery. While the judgment entered on that verdict is final, the question remains whether the district court properly directed a verdict against appellant as to penalty and attorney's fees on the $5,000 policy.

Section 56-1206 of the Georgia Code provides that if an insurer refuses to cover a loss within sixty days after demand and if there is a...